Hi I am newly registered I have high thyroid peroxidase antibodies? Symptoms are joint and muscle pain, fatigue, puffy feeling under eyes, feeling cold. Also cysts on ovaries which I have been told are from polycystic ovary syndrome. Thank you

Have you been diagnosed with hypothyroidism and are you on Levo? Hopefully because your results scream it!

THYROID PEROXIDASE ANTIBODIES 475 (<34)

THYROID STIMULATING HORMONE 13.2 (0.2 - 4.2)

Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results. You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Read and learn about Hashi's so that you can help yourself, most doctors dismiss antibodies as being of no importance and don't understand the nature of Hashi's and how it can affect your test results and symptoms.

Flower - I assume the 25mcg is a starter dose and you've just been diagnosed?

If so then you need regular retesting/increase of 25mcg every 6-8 weeks now until your symptoms abate and you feel well. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

When booking thyroid tests, always book the very first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.

Do not leave the surgery without a prescription for 50mcg Levo, then make sure you have the regular 6-8 weekly follow up tests with increases of 25mcg each time.

It might be an idea to see a different GP if possible, point out that you have been kept on a very low starter dose of Levo for 4 years and you believe the other GP has been negligent.

**

You will have to address the Hashi's as suggested, and if you haven't had the vitamin and mineral tests then ask for those to be done straight away.

Hashi's goes hand in hand with gut/absorption problems and this often leads to low nutrient levels in Hypo/Hashi's patients so it's important to get these tested. Post the results when you have them for comment and suggestions to deal with any low levels/deficiencies.

You should have been retested after six weeks and your dose increased by 25 mcg. And that cycle should have been repeated until your TSH came down to one or under, or wherever it needed to be for your FT4 and FT3 to be up near the top of the range, and all your symptoms resolved.

You should make an appointment immediately with your doctor, for an increase in dose. And, unless you get it immediately, plus the promise of a retest in six weeks, make a formal complaint against him. He is not fit to be a doctor with thyroid patients.